“Confronting the human consequences of war through clinical neuroscience research”

It has been an incredible privilege to be part of the making of Searching For Home. A major reason for this is that the mission of the film aligns nicely with the motivations and vision for the science happening in my laboratory at Stanford and the Palo Alto VA. I am a psychiatrist and a neuroscientist, holding an MD and a PhD. As such, I care deeply about outcomes for my patients (and those more generally suffering with psychiatric disorders) – and I believe that the best way I can have the broadest positive impact is by doing innovative neuroscience research while keeping my eye on the clinical “ball”.

The Truth: aligning neuroscience with clinical reality

As the film shows, coming back from war is no easy task. Many Vets struggle with post-traumatic stress disorder (PTSD), depression, traumatic brain injuries

Vietnam soldiers

(TBI), and addiction. Many never seek treatment for lack of a clear understanding of what ails them and because of the social stigma associated with mental illness. And for those that enter treatment, how do they fare? Unfortunately, the answer is not a rosy one. Treatments, such as psychotherapy and medication, can be very helpful, even transformative, for some people. But for others, they bring only modest or no relief. Medications, when they work, may need to be taken for weeks or months before effects are clear. And these outcomes are not for the lack of caring, dedicated and motivated clinicians!

We simply have to do better. We have to overcome the barriers of stigma (especially challenging in military populations). We have to get people the treatments that would most benefit them faster, but also need to develop entirely new types of treatments. We cannot accept the status quo as “good enough.” Moreover, these challenges are not restricted to Veterans and war, but rather reflect the status of psychiatric treatment more broadly. Advances aimed at conditions common in Vets would have huge impact on recovery from mental illnesses in the general population.

Kenny Bass, US Marine veteran Iraq War and service dog, Atlas.

The Healing: neuroscience research as a path forward
How does work in neuroscience research advance the healing from the “invisible” wounds of war? PTSD, depression, TBI, and other psychiatric disorders have been termed the invisible wounds of war since they are not as externally obvious as loss of a limb, yet they are just as real and impactful, if not more so. The invisible wounds manifest as disruptions of an organ – the brain – and we can capture these disruptions using brain imaging tools. Fundamentally, psychiatric disorders are illnesses of an organ in the same way that pneumonia is an illness of the lung or cirrhosis is an illness of the liver. In my lab, we use imaging along with other biological tools to understand what characterizes people who respond to treatment compared to those who do not. We are also learning about how treatment changes brain mechanism. Even talk therapy work by causing changes in the brain itself. Currently treatment modalities such as medication, psychotherapy, brain stimulation etc are being developed in isolation, based on completely different conceptual backgrounds. We hope in upcoming projects to put all of the current treatments for these conditions on the same neurobiological “playing field” so that they can speak the same language, the language of the brain. Moreover, by using a common language, we will be better able to identify which treatment would be best for any one patient.

In all of these ways, neuroscience can allow us to get the person to the “right” treatment and get there faster, as well as monitor the progress of treatment long before symptoms improve. This is not yet possible in the current way clinical care is delivered. Moreover, by demonstrating the biological realities of “invisible” mental conditions, I hope that the stigma around psychiatric disorders can be relieved and barriers to seeking of care can be overcome.

The Hope: neuroscience-driven innovations, and imagining a different future for our Veterans
Even with personalized treatment selection, many patients will still not respond well enough. What can we do for them? My lab is deeply interested and invested in this challenge. In parallel with our continually deepening understanding of brain problems in PTSD, depression and TBI, we have embarked on an aggressive course to develop new interventional tools capable of targeting them directly. For example, using new non-invasive brain stimulation approaches, we are directly targeting disrupted brain circuits, working to reach deeper into the brain and induce more lasting therapeutic changes. My hope is that within the span of my career we will be able to diagnose based on neurobiology and not symptoms alone, and have the tools to effectively treat the problems plaguing each individual patient’s brain.

-Dr. Amit Etkin MD Ph.D. Dr. Etkin is a psychiatrist and neuroscientist at Stanford University. Scientific Advisor to the film, “Searching for Home: Coming Back from War”. http://etkinlab.stanford.edu/